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Aim: To test whether the occupancy of shorebirds has changed in the eastern Canadian Arctic, and whether these changes could indicate that shorebird distributions are shifting in response to long-term climate change Location: Foxe Basin and Rasmussen Lowlands, Nunavut, Canada Methods: We used a unique set of observations, made 25 years apart, using general linear models to test if there was a relationship between changes in shorebird species’ occupancy and their Species Temperature Index, a simple version of a species climate envelope. Results: Changes in occupancy and density varied widely across species, with some increasing and some decreasing. This is despite that overall population trends are known to be negative for all of these species, based on surveys during migration. The changes in occupancy that we observed were positively related to the Species Temperature Index, such that the warmer-breeding species appear to be moving into these regions, while colder-breeding species appear to be shifting out of the regions, likely northwards. Main Conclusions: Our results suggest that we should be concerned about declining breeding habitat availability for bird species whose current breeding ranges are centred on higher and colder latitudes.

The objective of this quality initiative was to evaluate the process of implementing a new protocol using the Iowa model and evidence-base interventions. The first aim included deploying a protocol guiding sedation with dexmedetomidine for up to 24 h; the procedure involved non-intubated pediatric patients in the pediatric intensive care unit (PICU) while monitored by certified registered nurses. Dexmedetomidine is supported within the literature to be a safe and effective medication for pediatric patients, exceeding 24 h, without the adverse event of respiratory depression. The second aim was to then evaluate the implementation process. A pre-post educational approach was used, over a five-month period. Thirty-two nurses were educated and surveyed on their knowledge and attitudes regarding the use and administration of dexmedetomidine. The evaluation of pre and post knowledge surrounding dexmedetomidine was concluded following the post-survey. The evaluation of pre-post education showed, greater than 90% of the attending nurses, had an increase in their knowledge and understanding of safe use and monitoring for dexmedetomidine sedations in children. This quality initiative further supports effective application of evidence-based interventions. Moreover, using the Iowa model allowed for the effective execution in driving change, promoting sustainability, and improving safety in the delivery of care for pediatric patients receiving dexmedetomidine for long-term sedation.

Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive lung disease of unknown cause occurring in adults and affecting approximately 5 million people worldwide. The American Thoracic Society 2015 guidelines provide recommendations for the treatment of patients with IPF, including supportive care measures such as oxygen therapy, pulmonary rehabilitation, gastric acid therapy, sleep apnea, vaccinations, lung transplant evaluation, and pulmonary hypertension assessment. A smart-phrase was developed that outlines the supportive care measures for the IPF patient, which was then implemented into a new patient clinic note in the electronic medical record. Documentation of the measures improved significantly after implementation of the smart-phrase.

Background Despite decades of research, pressure injuries continue to be a source of significant pain and delayed recovery for patients and substantial quality and cost issues for hospitals. Consideration of the current thinking around pressure injury risk must be evaluated to improve risk assessments and subsequent nursing interventions aimed at reducing hospital-acquired pressure injuries. Design This is a discursive paper using Walker and Avant's (2005) theory synthesis framework to examine the relevance of existing pressure injury models as they align with the current literature. Methods PubMed and CINAHL indexes were searched, first for conceptual models and then for pressure injury research conducted on hospitalised patients for the years 2006-2016. A synthesis of the searches culminated into a new pressure injury risk model. Conclusions Gaps in previous models include lack of attention to the environment, contributing episode-of-care factors and the dynamic nature of injury risk for patients. Through theory synthesis, the need for a new model representing the full risk for pressure injury was identified. The Pressure Injury Predictive Model is a representation of the complex and dynamic nature of pressure injury risk that builds on previous models and addresses new patient, contextual and episode-of-care process influences. The Pressure Injury Predictive Model (PIPM) provides a more accurate picture of the complexity of contextual and process factors associated with pressure injury development. Relevance to clinical practice Using the PIPM to determine risk can result in improved risk identification. This information can be used to implement targeted, evidence-based pressure injury prevention interventions specific to the patient risk profile, thus limiting unwarranted and unnecessary care.

We describe a case of a term female infant born in a rural community hospital and who developed a left-sided spontaneous tension pneumothorax shortly after birth. We used telemedicine to guide the family physician and healthcare team at the referring hospital to perform a life-saving thoracentesis using an intravenous cannula. The cannula was kept in place to drain the persistent pneumothorax during transportation to the pediatric intensive care unit at the tertiary hospital.

Falls are common adverse events following hospital discharge. However, prevention programs are not tailored for older patients transitioning home. To inform development of transitional fall prevention programs, nine older adults designated as being at risk of falls during hospitalization who were recently discharged home were asked about their perceptions of fall risk and prevention, as well as their knowledge and opinion of materials from the Centers for Disease Control and Prevention Stopping Elderly Accidents, Deaths & Injuries Initiative. Using the constant comparative method, five themes were identified: Sedentary Behaviors and Limited Functioning ; Prioritization of Social Involvement ; Low Perceived Fall Risk and Attribution of Risk to External Factors ; Avoidance and Caution as Fall Prevention ; and Limited Falls Prevention Information During Transition from Hospital to Home . Limited awareness of and engagement in effective fall prevention may heighten recently discharged older adults' risks for falls. Prevention programs tailored to the post-discharge period may engage patients in fall prevention, promote well-being and independence, and link hospital and community efforts. [ Journal of Gerontological Nursing, 45 (1), 23–30.]

Urban students are increasingly diverse in race, culture, language, and background knowledge. Educators must consider how students’ differences affect learning and align pedagogies that address this diversity. Universal design for learning (UDL) has provided educators with a framework for differentiation to address learner differences. Using UDL principles without explicitly considering how cultural differences and perspectives affect learning may increase the disparity in student achievement for students of color. Likewise, the same applies to the effect of socioeconomic status or language development on students’ preparation for learning in a “typical” school environment. Culturally responsive pedagogies prompt educators to design instruction from the perspective of students’ diversity as strengths rather than deficits. Frequently overlooked aspects of culturally responsive pedagogy are compared with the facets of the UDL framework to provide teachers with additional considerations when planning for effective instruction.

More than 200 million people in 70 countries are exposed to arsenic through drinking water. Chronic exposure to this metalloid has been associated with the onset of many diseases, including cancer. Epidemiological evidence supports its carcinogenic potential, however, detailed molecular mechanisms remain to be elucidated. Despite the global magnitude of this problem, not all individuals face the same risk. Susceptibility to the toxic effects of arsenic is influenced by alterations in genes involved in arsenic metabolism, as well as biological factors, such as age, gender and nutrition. Moreover, chronic arsenic exposure results in several genotoxic and epigenetic alterations tightly associated with the arsenic biotransformation process, resulting in an increased cancer risk. In this review, we: 1) review the roles of inter-individual DNA-level variations influencing the susceptibility to arsenic-induced carcinogenesis; 2) discuss the contribution of arsenic biotransformation to cancer initiation; 3) provide insights into emerging research areas and the challenges in the field; and 4) compile a resource of publicly available arsenic-related DNA-level variations, transcriptome and methylation data. Understanding the molecular mechanisms of arsenic exposure and its subsequent health effects will support efforts to reduce the worldwide health burden and encourage the development of strategies for managing arsenic-related diseases in the era of personalized medicine. Keywords: Arsenic, Environmental carcinogens, Drinking water, Genetic susceptibility, Epigenetics, Cancer

Gene function in cancer is often cell type-specific. The epithelial cell-specific transcription factor ELF3 is a documented tumor suppressor in many epithelial tumors yet displays oncogenic properties in others. Here, we show that ELF3 is an oncogene in the adenocarcinoma subtype of lung cancer (LUAD), providing genetic, functional, and clinical evidence of subtype specificity. We discover a region of focal amplification at chromosome 1q32.1 encompassing the ELF3 locus in LUAD which is absent in the squamous subtype. Gene dosage and promoter hypomethylation affect the locus in up to 80% of LUAD analyzed. ELF3 expression was required for tumor growth and a pan-cancer expression network analysis supports its subtype and tissue specificity. We further show that ELF3 displays strong prognostic value in LUAD but not LUSC. We conclude that, contrary to many other tumors of epithelial origin, ELF3 is an oncogene and putative therapeutic target in LUAD., Tissue context can dictate why a gene can have seemingly opposing functions in different settings. ELF3 is tumor suppressive in many cancers of epithelial origin but in lung cancer, the authors describe an oncogenic role in the adenocarcinoma histology of non-small cell lung cancer.

Based upon an awareness of the need to increase its policy footprint, the American Association of Colleges of Nursing's (AACN) Board of Directors convened a think tank of nurse experts in the field of policy curriculum to advise the Board. The goal of the think tank was to review the current landscape, analyze trends, and create a set of recommendations for AACN's Board to consider. The Faculty Policy Think Tank (FPTT) met between 2016 and 2017 to review and reflect on methods to increase expertise of nursing faculty and students in health policy and make recommendations to the AACN Board to advance the agenda of the organization, member schools, and the profession. This article describes the methods and processes the Think Tank employed to develop a set of recommendations for the AACN Board of Directors.

Lung cancer is the leading cause of cancer death worldwide, and has a five-year survival rate of 18% [1]. MARK2 is a serine/threonine-protein kinase, and is a key component in the phosphorylation of microtubule-associated proteins [2,3]. A recent study published by Hubaux et al. found that microtubule affinity-regulating kinase 2 (MARK2) showed highly frequent DNA and RNA level disruption in lung cancer cell lines and independent non-small cell lung cancer (NSCLC) cohorts [4]. These alterations result in the acquisition of oncogenic properties in cell lines, such as increased viability and anchorage-independent growth. Furthermore, a microarray-based transcriptome analysis of three short hairpin RNA (shRNA)-mediated MARK2 knockdown lung adenocarcinoma cell lines (GEO#: GSE57966) revealed an association between MARK2 gene expression and cell cycle activation and DNA damage response. Here, we present a detailed description of transcriptome analysis to support the described role of MARK2 in promoting a malignant phenotype.

Background Asthma exacerbation risk increases with worsening asthma control. Prevailing numerical control tools evaluate only current symptom impairment despite the importance of also assessing risk based on exacerbation history. An easy-to-use questionnaire addressing impairment and risk domains of control is needed. Objective To validate a composite asthma control tool that includes impairment and risk assessments (Asthma Impairment and Risk Questionnaire [AIRQ]). Methods Four-hundred forty-two patients aged ≥12 years with physician-diagnosed asthma who were followed in specialty practices completed 15 impairment and risk questions with dichotomized yes/no responses. Patients spanned all Global Initiative for Asthma severities and were classified as well-controlled, not well-controlled, or very poorly controlled according to a standard of Asthma Control Test (ACT) score plus prior-year exacerbations. Logistic regression analyses identified questions with the greatest predictive validity to discriminate among patients and determine cut points for these 3 classifications. Results The final AIRQ comprises 10 equally weighted yes/no impairment and risk questions. The final 10-item models yielded receiver operating characteristic curves of 0.94 to identify well-controlled versus not well-/very poorly controlled and 0.93 to identify well-/not well-controlled versus very poorly controlled asthma, as reflected by the ACT plus prior-year exacerbations standard. Cut points of 0-1, 2-4, and 5-10 best represented well-, not well-, and very poorly controlled asthma. Conclusions AIRQ is a rigorously validated composite measure designed to identify adults and adolescents with varying degrees of asthma control. Ongoing investigations will determine test-retest reliability, responsiveness to change, and predictive ability for future exacerbations.

Made available in DSpace on 2019-10-06T15:22:30Z (GMT). No. of bitstreams: 0 Previous issue date: 2018-01-26 Canada Foundation for Innovation Canadian Institutes of Health Research University of British Columbia MicroRNAs (miRNAs) are crucial regulators of gene expression in normal development and cellular homeostasis. While miRNA repositories contain thousands of unique sequences, they primarily contain molecules that are conserved across several tissues, largely excluding lineage and tissue-specific miRNAs. By analyzing small non-coding RNA sequencing data for abundance and secondary RNA structure, we discovered 103 miRNA candidates previously undescribed in liver tissue. While expression of some of these unannotated sequences is restricted to non-malignant tissue, downregulation of most of the sequences was detected in liver tumors, indicating their importance in the maintenance of liver homeostasis. Furthermore, target prediction revealed the involvement of the unannotated miRNA candidates in fatty-acid metabolism and tissue regeneration, which are key pathways in liver biology. Here, we provide a comprehensive analysis of the undiscovered liver miRNA transcriptome, providing new resources for a deeper exploration of organ-specific biology and disease. Department of Integrative Oncology British Columbia Cancer Research Centre Krembil Research Institute University Health Network Faculty of Medicine São Paulo State University (UNESP) Faculty of Medicine São Paulo State University (UNESP) Canada Foundation for Innovation: 225404 Canada Foundation for Innovation: 30865

Hypoxia promotes tumour aggressiveness and reduces patient survival. A spectrum of poor outcome among patients with hypoxic tumours suggests that additional factors modulate how tumours respond to hypoxia. PIWI-interacting RNAs (piRNAs) are small non-coding RNAs with a pivotal role in genomic stability and epigenetic regulation of gene expression. We reported that cancer type-specific piRNA signatures vary among patients. However, remarkably homogenous piRNA profiles are detected across patients with renal cell carcinoma, a cancer characterized by constitutive upregulation of hypoxia-related signaling induced by common mutation or loss of von Hippel-Lindau factor (VHL). By investigating >3000 piRNA transcriptomes in hypoxic and non-hypoxic tumors from seven organs, we discovered 40 hypoxia-regulated piRNAs and validated this in cells cultured under hypoxia. Moreover, a subset of these hypoxia-regulated piRNAs are regulated by VHL/HIF signaling in vitro. A hypoxia-regulated piRNA-based score (PiSco) was associated with poor RFS for hypoxic tumours, particularly Stage I lung adenocarcinomas, suggesting that hypoxia-regulated piRNA expression can predict tumour recurrence even in early-stage tumours and thus may be of clinical utility.

Eleanor Flexner’s Century of Struggle: The Woman’s Rights Movement in the United States appeared in 1959, at the height of the Cold War and a decade before women’s history was recognized in the academy. Century of Struggle focused on suffrage but, rather than examining political rights narrowly defined, it integrated the struggles of African-American and working-class women into the story of political reform. It was remarkable for its topic, for being unabashedly connected to women’s rights as a social movement, and for rooting its argument in what today is called the intersectionality of gender, race, and class. It linked Flexner’s experiences in left-wing union advocacy and civil rights during the 1930s and 1940s to movements that flourished in the decades after Century was published.

There is an expanding interest in Local Food Systems (LFSs) in Vermont, along with a growing effort to create adaptive governance to facilitate action. In this case study, we investigate how adaptive governance of LFS can provide ideas and act as a catalyst for creating resilience in other social-ecological systems (SESs). By participating in meetings and interviewing stakeholders inside and outside the Vermont LFS network, we found that consumers were highly motivated to participate by supporting environmental issues, the local economy, and interactive communities, as well as building social relationships. Farmers experienced better income and increased respect in the local community. All participants found adequate &ldquo, safe space&rdquo, to share new ideas and explore partnerships. Their identities and values were also place-specific, reflecting the working landscape of Vermont. Adaptive governance was built on equal partnerships, where problems were discussed and responsibilities were shared among many stakeholders across geographic areas and multiple sectors. Some skepticism was expressed towards mainstreaming local food production and sales. Challenges remain to more fully include farmers, for-profit players, and low-income consumers in the network. This might limit the resilience and sustainability of the LFS. Because SESs are held together by common culture and identities, the risk of non-adaptive social patterns exemplifies one key challenge for future adaptive management towards resilient and sustainable outcomes. There is a critical need for developing relevant theory and conducting further research on LFSs and their potential roles in local SESs.

We examined serum samples from adults ages 48–64 who received multiple seasonal influenza vaccines from 2004 to 2009 for cross-neutralizing antibodies to potential pandemic strains. Using pseudoviruses bearing various hemagglutinins (HA-pseudoviruses), we found serum neutralization titers (≥160) in 100% against A/Japan/305/1957 (H2N2), 53% against A/Hong Kong/1073/99 (H9N2), 56% against the H3N2 variant A/Indiana/08/11 (H3N2v), 11% against A/Hong Kong/G9/97 (H9N2), and 36% A/chicken/Hong Kong/SF4/01 (H6N1). None had titers >160 to A/Shanghai/2/13 (H7N9) or A/Netherlands/219/03 (H7N7). Thirty-six percent to 0% had neutralization titers to various H5N1 strains. Titers to H9, H6, and H5 HA-pseudoviruses correlated with each other, but not with H3N2v, suggesting group-specific cross-neutralization.

Mary Montie,1 Clayton Shuman,1 Jose Galinato,1 Lance Patak,2 Christine A Anderson,1 Marita G Titler1 1Department of Systems, Populations, and Leadership, School of Nursing, University of Michigan, Ann Arbor, MI, 2Department of Anesthesiology and Pain Medicine, Seattle Children’s Hospital, Seattle, WA, USA Background: Call light systems remain the primary means of hospitalized patients to initiate communication with their health care providers. Although there is vast amounts of literature discussing patient communication with their health care providers, few studies have explored patients’ perceptions concerning call light use and communication. The specific aim of this study was to solicit patients’ perceptions regarding their call light use and communication with nursing staff. Methods: Patients invited to this study met the following inclusion criteria: proficient in English, been hospitalized for at least 24 hours, aged ≥21 years, and able to communicate verbally (eg, not intubated). Thirty participants provided written informed consent, were enrolled in the study, and completed interviews. Results: Using qualitative descriptive methods, five major themes emerged from patients’ perceptions (namely; establishing connectivity, participant safety concerns, no separation: health care and the call light device, issues with the current call light, and participants’ perceptions of “nurse work”). Multiple minor themes supported these major themes. Data analysis utilized the constant comparative methods of Glaser and Strauss. Discussion: Findings from this study extend the knowledge of patients’ understanding of not only why inconsistencies occur between the call light and their nurses, but also why the call light is more than merely a device to initiate communication; rather, it is a direct conduit to their health care and its delivery. Keywords: nurse–patient communication, medical technology, quality of care, qualitative research, patient safety, nurse work

The imprinted DLK1-DIO3 locus at 14q32.1-32.31 holds biological significance in fetal development, whereby imprinting errors are causal to developmental disorders. Emerging evidence has implicated this locus in other diseases including cancer, highlighting the biological parallels between fetal organ and tumour development. Areas covered: Controlled regulation of gene expression from the imprinted DLK1-DIO3 locus at 14q32.1-32.31 is crucial for proper fetal development. Deregulation of locus gene expression due to imprinting errors has been mechanistically linked to the developmental disorders Kagami-Ogata Syndrome and Temple Syndrome. In adult tissues, deregulation of locus genes has been associated with multiple malignancies although the causal genetic mechanisms remain largely uncharacterised. Here, we summarize the genetic mechanisms underlying the developmental disorders that arise as a result of improper locus imprinting and the resulting developmental phenotypes, emphasizing both the coding and noncoding components of the locus. We further highlight biological parallels common to both fetal development and disease, with a specific focus on lung development, respiratory disease, and lung cancer. Expert commentary: Many commonalities between respiratory and developmental defects have emerged with respect to the 14q32 locus, emphasizing the importance of studying the effects of imprinting on gene regulation patterns at this locus in both biological settings.

Here we introduce a two-photon Direct Laser Writing (DLW) strategy to create arrays of dual-structured microposts that vary in height (and therefore, stiffness) from post-to-post for cell mechanobiological studies. Using the Nanoscribe Professional GT system, we tuned the mechanical stiffness of each arrayed micropost through changes in relative heights of dual-structured posts. ANSYS simulations revealed that the theoretical stiffness of microposts could be modulated in the range of 2 to 250 nN/μm over the length of an array. Experimental results obtained from seeding human umbilical vein endothelial cells (HUVECs) revealed cell-generated traction forces up to 37.1 +/−7.2 nN. We envision that the ability to measure the traction forces of cells seeded on the presented stiffness gradients will enable researchers to better understand, and subsequently, control cellular behaviors, thereby impacting fields including tissue engineering, biomaterials, and regenerative medicine.

Recent years have yielded substantial advancement by clinical track faculty in cohort expansion and collective contributions to the discipline of nursing. As a result, standards for progression and promotion for clinical faculty need to be more fully developed, articulated, and disseminated. Our school formed a task force to examine benchmarks for the progression and promotion of clinical faculty across schools of nursing, with the goal of guiding faculty, reviewers, and decision makers about what constitutes excellence in scholarly productivity. Results from analyses of curriculum vitae of clinical professors or associate professors at six universities with high research activity revealed a variety of productivity among clinical track members, which included notable diversity in the types of scholarly products. Findings from this project help quantify types of scholarship for clinical faculty at the time of promotion. This work provides a springboard for greater understanding of the contributions of clinical track faculty to nursing practice.